Medical Management Of Breast Cancer Research Articles

Evaluating the acceptability, usability, and feasibility of a clinic-based genetic testing risk assessment intervention in Black women with breast cancer.

436 Background: Black women diagnosed with breast cancer utilize genetic counseling and testing services less often than White women despite these services having the potential to personalize medical management of breast cancer and identify family members for cascade testing. Lower rates of provider recommendations may be a driver of these disparities, as uptake does not appear to differ by race. The objective of this study was to evaluate the acceptability, usability, and feasibility of a clinic-based genetic risk assessment to facilitate provider recommendations for genetic testing in Black women diagnosed with breast cancer. Methods: A clinic-embedded, race-concordant, trained navigator administered a 15-minute screening tool based on National Comprehensive Cancer Network genetic testing criteria to English-speaking, Black women ≥18 and newly diagnosed with breast cancer. A copy of the results were given to the treating surgeon to facilitate consideration of genetic testing for the patient. However, the decision to recommend genetic testing was left to discretion of the surgeon. After enrollment completion, we conducted semi-structured interviews with a subsample of patients and surgeons who participated in the intervention to elicit their perspectives and experiences. We also used medical record data to determine if surgeons recommended genetic testing to participating patients, and if so, whether they completed it. Results: Between January 2022 and April 2023, 37 patients with a median age of 56.9 years (IQR 15.0-37.5) consented to participate. Surgeons recommended genetic testing to 25/37 patients and 5/37 additional patients were referred outside of this intervention (81.1% total). 12/37 patients (including those who were and were not recommended genetic testing) and 4/4 surgeons completed follow-up interviews. For clinician usability and acceptability, surgeons reported little to no negative impact on their clinic flow. While some found the intervention to be a helpful reminder, others shared it made no discernible impact on their practice, as they reported already incorporating a similar system into their clinic flow. For patient usability and acceptability, some patients found questions on the screening tool difficult to answer and expressed feeling overwhelmed at the time it was administered but the navigator was comforting, reassuring, and informative. Patients, surgeons, and the navigator recommended administering the screening tool prior to the initial appointment with the surgeon and ensuring follow up with patients regarding results. Conclusions: Participating patients and surgeons found this intervention to be feasible and acceptable. Usability challenges warrant further exploration into the logistics of the intervention, including timing, delivery, and medium.

Evaluation of a Question Prompt List on Treatment Decision-making Outcomes in Women Following Surgery for Breast Cancer: A Randomized Controlled Trial

Background: With advances in healthcare options for the medical management of breast cancer, treatment decision-making has become more complex. Objectives: Guided by self-efficacy theory, the study investigated the impact of a question prompt list (QPL) on decision-making outcomes among women with breast cancer in Iran who were post-surgery. Methods: A randomized controlled trial was conducted at a comprehensive cancer center in Tehran, Iran. Fifty patients were randomized to either a QPL with usual care (n = 25) or to a usual care (n = 25) condition. Data were collected pre- and post-treatment utilizing: 9-item Shared Decision-Making Questionnaire; Decision Self-efficacy Scale; and the Control Preferences Scale. Utilizing SPSS 26 software, descriptive, Shapiro-Wilk test, independent t-test, Fisher's Exact test, and Mann-Whitney U test were used. Results: No differences between the usual care and QPL groups on major study constructs were found (P > 0.05). Conclusions: The QPL did not impact various decision-making outcomes among women with breast cancer post-surgery. Cross-cultural research is needed with larger samples to further examine the impact of decision aids such as QPL on decision-making outcomes for women with breast cancer.

Systemic therapy for breast cancer during SARS-CoV-2 pandemic

The global community is currently facing the unprecedented challenge of the coronavirus disease 2019 (COVID-19) pandemic. More than 1 million cases have been reported until now. Increased mortality is reported in patients who are older and have cancer and multiple comorbidities. Few retrospective analyses of COVID-19 in cancer patients showed a higher mortality of about 28.6%; additionally, severe events are more in patients who develop infection within 2 weeks of receiving anticancer treatment. Clinical data separately analyzing breast cancer patients are lacking. Until an effective drug/vaccine develops, the clinical management is supportive, and pandemic control lies in non-pharmacologic interventions such as social distancing, testing, tracing, isolation, and quarantine. These measures hinder the proper care of breast cancer patients in all the three domains of clinical care, education, and research. These desperate circumstances need desperate measures. In this review, we highlight the medical management of breast cancer during this pandemic. An adoptive strategy is the need of the hour to balance both cancer care and COVID-19 management.

Queering Healthcare: Why Integrating Cultural Humility into Medical Education Matters for LGBTQ+ Patients

The medical field is still grappling with how to understand and situate LGBTQ+ patients within healthcare settings. The medicalization of LGBTQ+ identities and the legacy of heteronormativity in the medical field has situated these patients within narrow understandings of gender and sexual orientation. In this paper I outline how the medicalization of queerness and medical management of breast cancer have marginalized LGBTQ+ breast cancer patients as they proceed through diagnosis, treatment, and survivorship. Next, I link medicalization to the broader process and context of medical education, specifically the patient-provider relationship, where cross-cultural communication strategies, such as cultural competency training, are being utilized in an effort to understand LGBTQ+ health disparities. However, this approach has limited clinicians’ abilities to examine how their own cultural standpoints influence the care of LGBTQ+ patients. In response, I discuss how an alternative approach, cultural humility, motivates clinicians to examine their own cultural biases and assumptions as well as the power imbalances inherent in the patient-provider relationship. Data collection included reviewing studies related to cultural humility, LGBTQ+ health disparities, and how medical education approaches LGBTQ+ health. Using an integrative analysis of the literature, I outline how these studies suggest cultural humility is efficacious in equalizing patient-provider relationships and generating growth through awareness of how identity is relevant to health and healthcare. In conclusion I explore how this change in medical education revolutionizes our understanding of LGBTQ+ individuals’ health both by centering and privileging the voices of LGBTQ+ patients and examining how the patient-provider interaction is shaped by sociocultural context.

Breast Education in General Surgery Residency

Breast cancer treatment has changed substantially with increased specialization. Overall, the number of cases performed by residents upon completion of residency has decreased and the introduction of sentinel lymph node biopsy has reduced the number of axillary lymph node dissections being performed. Our objective was to evaluate the breast surgery education being provided by general surgery residency programs. A survey was administered to applicants to the Roswell Park Cancer Institute surgical oncology fellowship program in the fall of 2009. This survey examined the type of training program, the breast surgery exposure, and applicant comfort with the medical and surgical aspects of breast cancer. The survey was completed by 29 of 35 applicants. Of the respondents, 83 per cent were chief residents. Overall, participants had comfort levels above 8 (of 10) with breast related cases. For modified radical mastectomies and axillary lymph node dissections the comfort level dropped below 8. Participants were least comfortable discussing the medical management of breast cancer. General surgery residents completing training were less comfortable operating in the axilla compared with the breast. The study suggests careful attention should be paid to assuring adequate breast education in surgical residency.

“Does That Make Me A Woman?”

Feminist scholars and activists writing about breast cancer care among women have highlighted the sexist and heterosexist assumptions often embedded in the medical management of breast cancer, and of mastectomy in particular. Despite these contributions, and some speculation that sexual minority women may be less interested in breast reconstruction, limited research explores sexual minority women’s lived experience of mastectomy and decision making about reconstruction. Thirteen lesbian and/or bisexual women who had undergone mastectomy for treatment of breast cancer participated in individual qualitative interviews exploring decisions to have, or not have, breast reconstruction. Reasons for/against reconstruction reflected themes identified in prior studies among heterosexual women. Although participants described sexual, gender, and political identities and orientations as influences on their decision making, for most participants, experiences with physicians who encouraged reconstruction and concerns about stigmatization of illness in romantic, professional, and social contexts were also central. Findings are interpreted through feminist dis/ability, medicalization, and existential frameworks.

Recent advances in the medical management of breast cancer: highlights from the 29th San Antonio Breast Cancer Conference

The 29th edition of the San Antonio Breast Cancer Symposium was attended by a total of > 8000 basic scientists, translational researchers, clinical investigators and physicians gathering from ~ 80 countries worldwide. This is the largest meeting focusing on breast cancer, encompassing a wide array of topics from prevention, aetiology and diagnosis to molecular biology and treatment. From the main presentations at the meeting, it seems clear that combined efforts at prevention and treatment of this disease have translated into small, but significant, achievements. Much of the research in the area is focused on improving the therapeutic ratio of available treatments by better selection of patients.

The medical management of breast cancer. C. J. Williams and R. B. Buchanan. 246 × 189 mm. Pp. 340. 1987. Tunbridge Wells: Castle House Publicastions. £45.00

The medical management of breast cancer. C. J. Williams and R. B. Buchanan. 246 × 189 mm. Pp. 340. 1987. Tunbridge Wells: Castle House Publicastions. £45.00

Incidental Detection of Metastatic Lobular Breast Carcinoma in the Female Internal Genital Organs 2 Years Following Modified Radical Mastectomy

To present a rare case of breast cancer metastatic to the uterus, ovaries and fallopian tubes. A 76-year-old woman underwent total abdominal hysterectomy with bilateral salpingooophorectomy due to cervical intraepithelial neoplasia III with focal microinvasive squamous cell carcinoma of the cervix. Two years previously, she had undergone modified radical mastectomy and axillary lymph node dissection because of invasive lobular breast carcinoma. She subsequently received radiation therapy, chemotherapy and tamoxifen therapy. Pathologic examination of the removed internal genital organs incidentally detected metastatic lobular breast cancer. The present case provides evidence of breast cancer metastasis to the female internal genital organs. We suggest close gynecologic follow-up after surgical and medical management of breast cancer.

Medical management of breast cancer: today and tomorrow.

The medical management of invasive breast cancer has evolved based on the recognition that surgery alone was associated with few long-term cures. This Update will review the current status of breast cancer medical management in three areas: prevention in individuals with an elevated risk, adjuvant (postoperative) treatment of early breast cancer, and treatment principles in metastatic disease. Tamoxifen has emerged as a promising agent in the treatment of women at an increased risk for breast cancer and in those with in situ disease. However, the risks of treatment must be carefully weighed against the benefits in these cohorts of women with an excellent overall prognosis. This same principle can be applied to the use of adjuvant treatment in early invasive breast cancer, where the goal is cure. Adjuvant polychemotherapy is recommended in women considered at high-risk for relapse and death. In addition, women with hormone-sensitive breast cancer are offered adjuvant taxmoxifen. Nonetheless, there are some patients with low-risk disease or those with significant co-morbidities that are unlikely to benefit from adjuvant therapies and likely to sustain toxicities. The treatment goal in metastatic breast cancer is focused on palliation of symptoms as fewer than 10% of such patients achieve 5-year survival. However, novel targeted therapies are changing the treatment armamentarium and hold great promise. These new directions of treatment will be discussed as well as areas of controversy.

The Medical Management of Breast Cancer

The Medical Management of Breast Cancer

The Medical Management of Breast Cancer

The Medical Management of Breast Cancer

Book ReviewThe Medical Management of Breast Cancer

Book ReviewThe Medical Management of Breast Cancer

Controversies in the medical management of breast cancer.

Breast cancer is more of a medical than a surgical disease. Most patients presenting with clinically localised tumour sooner or later develop metastases from which they will die, and this occurs irrespective of the nature or intensity of their initial local treatment. In other words, breast cancer is usually a systemic disease from its clinical outset. Both endocrine therapy and cytotoxic chemotherapy are widely used in the treatment of breast cancer; indeed medically there are more therapeutic options available than for any other malignancy. Yet for the patient with overt clinical metastases these are only transiently effective and virtually never curative. This limitation of medical treatment has led to two large areas of controversy. First, how best should the various forms of endocrine therapy and cytotoxic chemotherapy be put together to achieve maximum palliative benefit in patients with advanced metastatic d'sease? Second, might endocrine therapy or chemotherapy have the potential for cure or prolongation of survival if used early in the course of the disease as an adjuvant to surgery at a time when metastases are clinically undetectable?

The medical management of breast cancer.

The medical management of breast cancer.

MEDICAL MANAGEMENT IN CARCINOMA OF THE BREAST.

The medical management of breast cancer actually begins with the first visit of the patient and continues throughout her entire life. It starts with educating the patient to be alert to suspicious signs and to develop a healthy attitude toward the disease when present. It continues with the first suspicion of a pathologic condition as revealed by an adequate history and a painstaking breast examination, the planning of proper diagnostic procedures to establish the diagnosis, the selection of the best available surgeon for definitive therapy and of the best available radiotherapist when the need for radiotherapy is indicated. Then it continues with postoperative follow-up, the decision as to the use of so-called prophylactic ancillary procedures, and finally the management of disseminated cancer which unfortunately occurs in the majority of women who have had breast cancer. I will confine my remarks to certain points that are especially pertinent to what the medical oncologist can contribute to the total care of the patient with breast cancer, as a member of the professional team together with the surgeon, the radiologist, and the pathologist (1). Although time is of the essence when a suspicious area is discovered in the breast, a reasonable search for evidence of metastases should be made before planning radical definitive surgical procedure. This should include not only the usual routine film of the chest but a careful search as well for evidence of distant metastases. Far too often patients are admitted to our disseminated breast cancer clinic with findings of metastases within one or two months after a radical mastectomy, and the history and physical findings suggest that the disease was already disseminated several months before the so-called definitive surgery. If a more complete work-up had been done before the decision to operate, the patient would have avoided unnecessary surgery. One of the commonest questions that arises at the time of radical mastectomy in patients who are premenopausal is whether castration should be done “prophylactically.”3 Adequate information as to the value of this procedure is not yet available. However, a retrospective study by B. J. Kennedy revealed no difference in the total survival between those patients castrated before dissemination of cancer was clinically evident and those castrated for disseminated disease (2). A national randomized study of the value of this procedure is now going on, but it is far too early for any valid conclusions to be made because of the great variability in the interval between the primary disease and the clinical manifestations of dissemination. It seems logical to assume, however, that clinical evidence of metastases might be delayed in about 30 per cent of the menstruants.